Serotonergic agents in the treatment of acute neuroleptic-induced akathisia: open-label study of buspirone and mianserin.
It has been suggested that dopamine/serotonin (5-HT) imbalance, with relative enhancement of serotonergic activity, might be one of the possible pathophysiological mechanisms underlying neuroleptic-induced akathisia. On the basis of preclinical data, which imply that the partial 5-HT1A agonist buspirone possesses anti-5-HT activity, in the present open-label study we examined the putative antiakathitic effect of buspirone in 10 neuroleptic-treated patients with acute neuroleptic-induced akathisia. Buspirone (up to 30 mg/day in divided doses) was administered for a trial period of 4 days (first part of the study). No significant changes in neuroleptic-induced akathisia as rated using the Barnes Akathisia Scale were detected during buspirone treatment. Buspirone was effective in only two neuroleptic-induced akathisia patients and caused worsening of akathisia in the other two patients. According to the study design, eight buspirone non-responders were switched to the 5-HT2A/2C antagonist mianserin (15 mg/day) for the other 4 days of treatment (second part of the study). Seven mianserin-treated patients improved and five revealed complete disappearance of neuroleptic-induced akathisia. It seems that the 5-HT1A partial agonist buspirone is of limited value in the treatment of acute neuroleptic-induced akathisia. It contrast, it appears that low-dose mianserin is therapeutically effective in acute neuroleptic-induced akathisia.
Poyurovsky
M
M
Research Unit, Tirat Carmel Mental Health Center, Israel.
Weizman
A
A
D000208:Acute Disease; D000328:Adult; D017109:Akathisia, Drug-Induced / Q000188:drug therapy* / Q000209:etiology; D014150:Antipsychotic Agents / Q000009:adverse effects*; D002065:Buspirone / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008803:Mianserin / Q000627:therapeutic use*; D008875:Middle Aged; D012559:Schizophrenia / Q000188:drug therapy; D018490:Serotonin Agents / Q000627:therapeutic use*
D014150:Antipsychotic Agents; D018490:Serotonin Agents; D008803:Mianserin; D002065:Buspirone